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. 2017 Jul;22(3):149-154.
doi: 10.1177/1355819616686807. Epub 2017 Jan 11.

Dying in hospital: socioeconomic inequality trends in England

Helen Barratt  1 , Miqdad Asaria  2 , Jessica Sheringham  3 , Patrick Stone  4 , Rosalind Raine  5 , Richard Cookson  6
Affiliations

Dying in hospital: socioeconomic inequality trends in England

Helen Barratt et al. J Health Serv Res Policy. 2017 Jul.

Abstract

Objective: To describe trends in socioeconomic inequality in the proportion of deaths occurring in hospital, during a period of sustained effort by the NHS in England to improve end of life care.

Methods: Whole-population, small area longitudinal study involving 5,260,871 patients of all ages who died in England from 2001/2002 to 2011/2012. Our primary measure of inequality was the slope index of inequality. This represents the estimated gap between the most and least deprived neighbourhood in England, allowing for the gradient in between. Neighbourhoods were geographic Lower Layer Super Output Areas containing about 1500 people each.

Results: The overall proportion of patients dying in hospital decreased from 49.5% to 43.6% during the study period, after initially increasing to 52.0% in 2004/2005. There was substantial 'pro-rich' inequality, with an estimated difference of 5.95 percentage points in the proportion of people dying in hospital (confidence interval 5.26 to 6.63), comparing the most and least deprived neighbourhoods in 2011/2012. There was no significant reduction in this gap over time, either in absolute terms or relative to the mean, despite the overall reduction in the proportion of patients dying in hospital.

Conclusions: Efforts to reduce the proportion of patients dying in hospital in England have been successful overall but did not reduce inequality. Greater understanding of the reasons for such inequality is required before policy changes can be determined.

Keywords: England; inequalities; palliative care; place of death.

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Figures

Figure 1.
Figure 1.
National social gradient in dying in hospital in 2011/2012. Dots represent deprivation decile groups. The slope of the line is the slope index of inequality. The shaded area shows the ‘inequity gap’. The dashed line shows the national average.
Figure 2.
Figure 2.
National equity trends in dying in hospital. The solid black line shows the most deprived quintile and the solid grey line shows the least deprived quintile. A positive slope index of inequality indicates a ‘pro-rich’ distribution in absolute terms. A positive relative index of inequality indicates a ‘pro-rich’ distribution in relative terms.
See this image and copyright information in PMC

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